I have been working in the field of lactation for more than 12 years. The question that I hear the most, year after year, is: “How do I know my breastfed baby is getting enough milk?”· First, let’s start with the size of a newborn’s stomach. It’s TINY! Day one is about the size of a small marble, day three is a larger, “shooter” marble, and day seven the newborn’s stomach measures about the same size as a ping pong ball.

Breastfed babies need to be fed, on average, every 2-3 hours in the newborn period. When I hear that a baby is “so easy, she sleeps all day!” that is a warning sign that baby may not be getting enough. A newborn who is hungry may quickly adapt by sleeping more to conserve energy and what looks like placidity may actually be hunger. So, I tell moms to feed the baby on demand (even if it means waking a sleeping infant), but not less than every 3 hours, day and night. If a baby has been struggling to gain weight, I advise feeding every two hours until weight gain steadies. This may seem like a lot, but remember that by day 7, the stomach is only as big as a ping-pong ball and breast milk is used and digested very quickly (about 20 mins). It may feel as if you are nursing all the time, but this initial period is so important in establishing breastfeeding and building the milk supply. If your baby is not meeting these“diaper goals”, consult a member of your health care team, as babies can quickly get into trouble with dehydration, especially in the newborn period. · Still not sure baby is getting enough? What comes in must come out. An easy way to see if your newborn is getting milk is to watch her wet and poopy diapers (better smelling with breast milk!). By day 3-4, babies should be stooling at least a couple of times a day and the product should resemble seedy mustard. Babies this age should also have at least 3-4 wet diapers. At the one week mark and for weeks beyond, you should see 6-8 wet diapers and 3-4 stools per day. It is not uncommon for breastfed babies to reduce their stooling frequency after the first month and, as long as it is still soft, it is not usually a problem. What about the baby that is nursing 8-12 times a day but is losing or not gaining any weight? It is normal for babies to lose some weight in the newborn period, but pediatricians like to see a return to birth weight by the two-week mark. If baby has not regained, we first look at the latch. It is possible for a baby to be sucking frequently but not effectively. The baby’s mouth should be over the dark area surrounding the nipple (the areola), so that the sucking will reach the milk ducts, not just the nipple itself. If a baby is sucking only on the end of the nipple, the result will be like biting on a straw – a closing off of the milk flow. Sucking on the nipple is also likely to cause pain for the mom, so if you are experiencing pain and/or your baby is not gaining well, evaluate your latch, ideally with the help of a lactation consultant, La Leche leader, or WIC peer counselor. Many visiting nurses are also trained in breastfeeding support and I urge mothers to take advantage of the free VNA postpartum visit that is usually offered through the hospital.

Breastfeeding is a natural process, but doesn’t always come naturally. Remember, taking the time to fix small problems at the beginning can help ensure a successful breastfeeding experience for both you and your baby. Still have questions? Email me at ghathawaylactation@gmail.com and check out my blog at www.hathawaylactation.blogspot.com